LIDOCAINE-INDUCED INTERMITTENT LEFT BUNDLE BRANCH BLOCK AND CHATTERJEE PHENOMENON

TOPIC: Cardiovascular Disease TYPE: Medical Student/Resident Case Reports INTRODUCTION: The frequency of new onset left bundle branch block (LBBB) during anaesthesia and surgery is rare. most common causes for LBBB are structural heart diseases, acute myocardial infarction, dilated cardiomyopathy, failure, exercise-induced LBBB[1]. We present a rare case Lidocaine-induced Intermittent Left Bundle Branch Block. CASE PRESENTATION: A 63-year-old female with no medical history had hysterectomy/high uterosacral ligament suspension as an elective procedure uterine prolapse. baseline EKG was normal. She went to the operating room scheduled, but after injection 100 mg local Lidocaine, she developed on ST-T changes (Figure-1). aborted, cardiology consulted Cardiac enzymes were Upon evaluation by team, patient particular complaints, soon her resolved spontaneously without any intervention. follow-up done few hours later showed normal sinus rhythm evidence T-wave inversion suggestive cardiac memory or "Chatterjee's phenomenon" (Figure-2). Echocardiogram Nuclear stress testing performed, which negative ischemic changes. DISCUSSION: There have been several reports adverse effects lidocaine conduction standard doses intravenous lidocaine. These included appearance type II second-degree block, asystole, complete in infant. One first cases transient induced reported back 1989 Tagliente et al[2]. It not understood how may induce LBBB; however, literature has suggested that high can cause delay within Purkinje system subsequently leading block. memory, Chatterjee's phenomenon, described 1969 Kanu Chatterjee al., defined deep ST depression un-paced following ventricular pacing[3]. also occur other patients abnormal electricity, including those intermittent LBBB, WPW, episodic tachycardia. CONCLUSIONS: On occasions, Lidocaine REFERENCE #1: Sarter BH, Hook BG, Callans DJ, Marchlinski FE. Effect electrogram morphologic features: implications arrhythmia diagnosis stored analysis. American journal. 1996;131(5):947-52. #2: TM, Jayagopal S. Transient Anesthesia & Analgesia. 1989;69(4):545-7. #3: K, Harris A, Davies G, Leatham A. Electrocardiographic subsequent artificial depolarization. British 1969;31(6):770 DISCLOSURES: No relevant relationships Mostafa Abohelwa, source=Web Response Monica Botros, Zeyad Elharabi, Mohamed Elmassry, Peter Khalil, Sima Shahbandar, Victor Test,